Transcript Ideas for the Precontemplator

Ideas for the PreContemplator
“I’m not ready to use hearing
aids!”
Stage 1: Precontemplation
“Who, me? I don’t have a
problem. People mumble!”
Stage 1: Pre-Contemplation
• During the pre-contemplation stage, the patient has
no intention of changing within the foreseeable future
(6 months)
• They may not be aware that they have a problem or
they may be unwilling to make a change
• Individuals in this stage are often labeled as “in
denial”, “resistant” or defensive about their current
status
• The cons of changing outweigh the pros of changing
Processes of Change for
Precontemplators
• Goal is for precontemplators to
acknowledge and/or increase their
awareness of the negative aspects of
their problem
• To move out of this stage, information
and feedback are needed
Pre-contemplation
• Review “Beyond Hearing Loss” video,
which gives an overview of hearing loss
issues
• Give statistical information comparing
hearing aid users to non-users
• Provide reading materials
• Audiologic Assessment
• HHIE screening
“Beyond Hearing Loss”
• 12 minute video
• Available from Johns Hopkins Center
for Hearing and Balance
• 410-955-6680
The Impact of Hearing Aid Usage
• Findings of National Council on Aging
www.ncoa.org (1999)
• Reports results of 2,069 hearing impaired
respondents
• Significantly higher incidences of anxiety,
frustration, and depression, and social
withdrawal, even in folks with mild losses
Pre-Contemplation
• Use drawings of cartoon-like characters
to start discussions about various
communication issues
• Use Erber (1988) “Eight Conversational
Occurrences” to initiate discussion
about communication problems and
hearing loss
I Feel Like I Work So Hard
I am exhausted from
working to hear
everyone
Pre-Contemplation
The boss said
he wanted the
money, not
that it was
sunny.
Conversational Occurrences
1. Perceived message correctly
•
•
Received meaningful message that was expected and appropriate
(“Where’s the main post office?” – “Two blocks down and turn right.”)
2. Perceived incorrect meaningful message
•
•
Received message that fit the conversation, but was incorrect
(Bad apples: “They’re not good for anything but chucking!” – actually, “chutney”)
3. Perceived meaningless message confidently
•
•
Perceived message clearly, but did not make sense and did not fit the
conversation
(“Didn’t she understand?” – “No. I explained it in my typical Garibaldi faction.”
Actually, “…typically garbled fashion.”)
Conversational Occurrences
Continued…
4. Perceived nonsense
•
•
Received syllables and word-like patterns, but could not understand them
(“Did you get all your work finished?” – “Mau fitr pekd laimmi aruipeng!”)
5. Perceived fragments
•
•
Received only part of the message
(“Why didn’t you buy the tape recorder?” – “Because we saw…………in the shop
window”)
6. Perceived (distorted) acoustic cues only
•
•
The speaker’s mouth was not visible
(as over the telephone; or his/her mouth was obscured by hair, a hand, or an
object)
Conversational Occurrences
Continued…
7. Perceived (incomplete) visible cues only
•
The speaker was too far away; the speaker’s voice level was too low; the hearing
aids and/or batteries were malfunctioning
8. Perceived nothing
•
The receiver was distracted or was not paying attention, so the speaker’s
utterance was neither heard nor seen
(Erber, 1988)
Signs and Symptoms
•
•
•
•
•
•
Frequently asking people to repeat
Inappropriate response to what is said
Difficulty understanding in groups
Puzzled expression when listening
Intently watching the speaker’s mouth
Strained expression around eyes
» Trychin, 2003
Signs and Symptoms
•
•
•
•
•
•
Turning the head to one side to hear better
Avoid social situations-withdraws
Talk too loudly or very softly
Turn up TV or radio much too loud
Blame people for not speaking clearly
Defensive about communication problems
» Trychin, 2003
Problem Situations
Reported by HOH
•
•
•
•
•
•
Hearing alarm signals
Voice from another room
Can’t see speaker’s face
Poor illumination
People whispering
Voices on TV or radio
» Trychin, 2003
Problem Situations
Reported by HOH
•
•
•
•
•
•
Conversations in a moving car
Family dinners at holidays
Understanding conversations on the phone
Several people talking
Medical situations
Outdoors-wind, traffic, etc.
Trychin, 2003
Problem Situations
Reported by HOH
•
•
•
•
•
•
Person whose speech is not clear
Misinterpretation of mistakes
Unaware person is talking to me
Movies, plays, lectures, classes
Stopped for traffic violations
Dancing and talking
» Trychin, 2003
Problem Situations:
Family
Members
Difficulty remembering what to do
•
• Not knowing whether she/he understands
• The variability in his/her ability to
understand
• Hard to get her/him to understand me
• TV or radio is much too loud
– Trychin & Albright, 1993
Problem Situations:
Family Members
•
•
•
•
Having to repeat often
Having to interpret too frequently
When we become frustrated or irritated
When she/he doesn’t pay attention
– Trychin & Albright, 1993
Problem Situations:
Family Members
• Not talking as much as before
• When he/she is not understanding
someone else
• Being asked to repeat embarrassing
jokes or remarks
» Trychin & Albright, 1993
Problem Situations:
Family Members
•
•
•
•
•
Becoming too dependent on me
Being isolated from friends and family
Not doing things we enjoyed previously
Having to repeat in pressure situations
Not traveling or going new places
» Trychin & Albright, 1993
Reactions
• Physical
• Emotional
• Behavioral
– Cognitive
• Trychin, 2001
Physical Reactions to
Communication Problems
•
•
•
•
•
•
Muscle tension-shoulders, neck, back
Stomach problems
Fatigue
Head aches
Increased blood pressure
Appetite changes-eat more, eat less
» Trychin, 1991
Behavioral Reactions to
Communication Problems
•
•
•
•
•
•
Bluffing
Withdrawing
Blaming
Demanding
Dominating conversations
Guilt tripping
» Trychin, 1991
Emotional Reactions to
Communication Problems
•
•
•
•
•
•
Anger
Anxiety
Depression
Embarrassment
Frustration
Guilt
» Trychin, 1991
Cognitive Reactions to
Communication Problems
•
•
•
•
•
•
Can’t think straight-confused
Hard to focus attention
Distracting thoughts
Distrustful of others
Decreased self esteem
Difficult to remember what you did not hear
clearly in the first place
»
Trychin, 1991
•
•
•
•
•
•
Mental Health Risks of
Hearing Loss
Becoming chronically nervous; Anxious
Becoming chronically sad; Depressed
Feeling anger much of the time
Loss of group identity
Feeling marginal in own family
Loneliness
» Trychin, 1991
Mental Health Risks of
Hearing Loss
•
•
•
•
•
•
•
Becoming distrustful of people
Withdrawing from social contact
Developing poor self-image
Feeling incompetent
Feeling unacceptable to others
Feeling marginal socially
Feeling loss of influence or control
» Trychin, 1991